EP0185490B1

EP0185490B1 - Antibacterial cream

Info

Publication number: EP0185490B1
Application number: EP85308814A
Authority: EP
Inventors: Peter David Holtshousen
Original assignee: Euro Celtique SA
Current assignee: Euro Celtique SA
Priority date: 1984-12-12
Filing date: 1985-12-04
Publication date: 1991-09-25
Anticipated expiration: 2005-12-04
Also published as: ES549814A0; ES8706437A1; IE853126L; US4671957A; NO854943L; PT81618A; IL77224A; CN85109101A; EP0185490A2; DE3584236D1; IE59827B1; PT81618B; FI854886A0; DK170630B1; DK574185A; NO171095B; ATE67668T1; NZ214496A; JPS61186312A; JPH0699298B2

Abstract

A topical, antibacterial cream contains an antibacterial agent and a base, the base having a 20 to 50% (w/w) content of hydrocarbon and polyol moisturising components. Preferably the antibacterial agent is an iodophor, especially povidone iodine, and the base contains a mixture of liquid and white petrolatum (as the hydrocarbon component) together with glycerine (as the polyol).

Description

This invention relates to topical, antibacterial creams particularly those suitable for topical application to burns, especially those containing the iodophor polyvinylpyrrolidone (povidone) iodine.
Topical Creams containing antibacterial agents, especially iodophors, are effective therapeutics for the treatment of burns and other skin disorders requiring rectification. However, this therapy is limited by the degree of penetration of the active substance through necrotic tissue, pus and other barriers between the surface of the wound and the deep areas of the wound. In these cases, significant therapeutic advantages are gained by using an additional topical preparation (often acidic in nature) to destroy these barriers and allow free penetration of the antibacterial agent deep into the wound.
It is a disadvantage of this method of treatment however, that the application of the additional (acidic) preparation must be highly controlled, since it is the intention to remove surface barriers only and not to penetrate this extra medication deep into the wound itself, where further tissue damage could result from acidic attack.
It is one object of the present invention to provide a topical, antibacterial povidone iodine cream that is suitable for topical application to burns, and that is effective without the use of an acidic preparation, (to destroy surface barriers).
Other objects and advantages of the present invention will become apparent from the following detailed description thereof.
Povidone iodine compositions are known in the art. For example, antiseptic skin ointments are described in US Patent 4,301,145. Reference to other povidone iodine containing compositions is made in the discussion of the background art disclosed therein.
According to the present invention, there is provided a topical, antibacterial cream containing an effective quantity of povidone iodine in a topical cream base, wherein the base is an oil-in-water emulsion containing water and 20 to 50 per cent (w/w) of a mixture of at least one hydrocarbon component and at least one polyol moisturising component.
The present cream has a far greater hydrocarbon/moisturiser content than prior art products. The present inventor has surprisingly found that this increased level of hydrocarbon/moisturiser in the cream results in an improved penetration of the antibacterial agent into wound tissue and thereby avoids the need for a preliminary (acidic) treatment and also leads to faster patient recovery.
Polyvinylpyrrolidone (povidone) is a non-ionic, non-detergent water-soluble, organic polymer that is characterised by an unusual complexing ability, by its colloidal properties and by its physiological inertness. Its iodine complex, polyvinylpyrrolidone (povidone) iodine, is a well known iodophor that is a highly effective germicide, providing a broad spectrum of microbiocidal action against virtually all microbes.
Povidone iodine may be prepared by any of a number of known routes, see, for example, European Published Applications No. EP-A-120301 and EP-A-6340, and British Patent No. GB-A-1580596.
The amount of iodine incorporated in the iodophor used in the present cream will be determined by, amongst other factors, the amount of iodophor present in the cream and the required antibacterial strength of the cream. Preferably, iodine will constitute between 1 and 20% (by wt.), especially between 2 and 15% (by wt.) of the iodophor dry weight.
The concentration of povidone iodine in the present cream will depend on the anti bacterial strength required. In addition, antibacterial agent concentration will be determined by, amongst other factors, the propensity of the agent to cause irritation, the length of use contemplated, the amount of iodine in the iodophor and the rate of iodine loss (when the cream is in use).
The cream preferably contains enough iodophor to afford a concentration of available (titratable) iodine within the cream of between 0.1 and 2% (by wt.), especially between 0.2 and 1.5% (by wt.).
Thus, a cream employing povidone iodine, with 10% (by wt.) available iodine, as an antibacterial agent, would preferably contain between 1 and 20%, especially 2 and 15% (by wt.) of povidone iodine.
The topical cream base of the present invention is an oil in water emulsion and must contain between 20 and 50 per cent (by wt.) of a mixture of hydrocarbon and polyol moisturising components. Preferably the cream base contains between 25 and 40 per cent (by wt.) of hydrocarbon/moisturising components.
The at least one hydrocarbon component of the present, cream base may be selected from any of the hydrocarbon oils and hydrocarbon bases that are well known in the pharmaceutical art. Suitable the hydrocarbon oils are mineral oil or liquid petrolatum, whilst suitable hydrocarbon bases are white petrolatum or white ointment (petrolatum with 5% beeswax).
In a preferred embodiment of the present invention, the at least one hydrocarbon components comprises between 15 and 40% (w/w), especially between 20-30% (w/w) of the topical cream base.
In a particularly preferred embodiment of the present invention, the at least one hydrocarbon component comprises a mixture of liquid petrolatum and white petrolatum.
The at least one polyol moisturising component of the present cream base may be selected from any of the polyol moisturising components that are well known in the pharmaceutical art.
Examples include propylene glycol and, which is preferred, glycerin.
In a preferred embodiment of the present invention, the at least one polyol moisturising component comprises between 5 and 20% (w/w), especially between 5 and 15% (w/w) of the topical cream base.
Although any ratio of hydrocarbon to polyol components that produces a satisfactory cream for topical application may be employed in the present cream base, the present inventor has found that ratios (w/w) between 1 to 1 and 4 to 1, especially a weight ratio of about 2 to 1, provide the most satisfactory cream bases for incorporation in the present topical cream.
In addition to hydrocarbon and polyol moisturising components, the present cream base will generally also contain at least one emulsifier, and, optionally but preferably, at least one surfactant.
Suitable emulsifiers include higher fatty alcohols, such as cetyl alcohol, stearyl alcohol, and cetostearyl alcohol, and partially esterified polyols such as glyceryl monostearate, polyethylene glycol monostearate and sorbitan monooleate.
Preferably emulsifiers are provided at a concentration between 1 and 15% (by wt.) of the cream base.
The present antibacterial cream must be of a viscosity that allows its topical application to the human or animal body. Preferably the cream will have a viscosity, at 25°C between 25,000 and 67,000 centipoises, when measured on a Brookfield (Trade Mark) LV Viscometer preferably between 30000 and 50000 centipoises.
In order to facilitate the preparation of the present cream there is provided a process for the preparation of a topical, antibacterial cream comprising forming a mixture of an effective quantity of povidone iodine and a topical cream base, wherein the base comprises 20 to 50% (w/w) of a mixture of at least one hydrocarbon component and at least one polyol moisturising component. In one embodiment of the present process, the cream is prepared by forming an aqueous solution containing at least one antibacterial agent and at least one polyol moisturising component and then mixing this aqueous solution with the at least one hydrocarbon component. In another, preferred, embodiment of the present process, the cream is prepared by forming an aqueous solution of at least one polyol moisturising component, mixing the aqueous polyol solution with at least one hydrocarbon component to form a base and adding an aqueous solution of the antibacterial agent to the base. In either case, further components, e.g. emulsifiers, may be dissolved in either the aqueous or the hydrocarbon phase, as desired.
In order to treat, for example, burns and other skin disorders, the present cream may be administered to the human or animal body by any of the conventional methods known in the medical/pharmaceutical art. For example, the cream may first be applied to a suitable dressing, such as a Teflon dressing, which is then placed on the wound tissue. The dressing may be held in place by a bondage. Generally, the dressing will be replaced every 12 to 24 hours. The cream may be applied alone or, although this is not necessary for successful treatment, in combination with a known acid cream, for example a benzoic acid containing cream, such as Aserbine (Trade Mark).
Clinical trials using a povidone iodine cream according to the present invention have shown that the cream affords an improved penetration of the povidone iodine into wounds and that the cream has a superior therapeutic profile, when compared with PVPI products (especially ointments) of the prior art which contain a low content of hydrocarbon and moisturising components. In particular, the present cream has an improved (i.e. shorter) recovery than these prior art products and does not require the use of a desloughing agent, as do the prior art products.
The present topical, antibacterial cream will now be described by way of example only.

Example 1

A topical antibacterial cream having the following ingredients

was prepared as follows:
The stearyl alcohol, cetyl alcohol, white petrolatum, liquid petrolatum, sorbitan monostearate and polyoxyethylene stearate were melted with mixing. Separately, PVPI was dissolved in water, after which the pH of the solution was adjusted to about 4.5 using NaOH.
An aqueous solution of polysorbate 60 and glycerine was then heated and added to the melt, with stirring, to form an emulsion. To the emulsion was added the PVPI solution, the whole being stirred until the batch reached room temperature. (During the final stage, water and/or hydroxide base may be added to the batch, as required).
The resulting cream had a viscosity of 40000 centipoise at 25°C, measured on a Brookfield LV viscometer.

Example 2

A topical, antibacterial cream having the following ingredients was prepared as described in Example 1:

Clinical Trial

Topical burn therapy comparing povidone iodine ointment or cream plus aserbine and povidone iodine cream

Materials

(a) 10% Povidone iodine (Betadine, Trade Mark) ointment was obtained from Napp Laboratories, Cambridge.
(b) 5% Povidone iodine cream was prepared as described in Example 1.
(c) Aserbine (Trade Mark) cream containing benzoic acid (0.025%), malic acid (0.375%), salicylic acid (0.006%), propylene glycol and hexachlorophane, was obtained from Bencard, UK.

Methods

Three groups, each consisting of 25 patients, were treated by topical application, on a once daily basis, of

(i) 10% Betadine ointment mixed in equal proportions with Aserbine cream, or
(ii) 5% Povidone iodine cream, or
(iii) 5% Povidone iodine cream mixed in equal proportions with Aserbine cream.

The daily application of fresh topical agent was preceded by wound cleansing in a whirlpool tank. Control of bacterial proliferation in the water and pump was achieved by adding PVPI to the water in a concentration of 3ppm. (This concentration has been shown to be effective in preventing bacterial proliferation and cross-contamination in hydrotherapy equipment).
Systemic antibiotics were not employed except in those patients manifesting with signs and symptoms of invasive infection.
The groups were comparable for age, size, type, depth and distribution of burn.

Results

All three preparations were applied easily and removed easily causing only mild discomfort on application in the majority of cases. Moderate discomfort on application was experienced by a few patients but was never severe enough to necessitate the use of analgesic agents. In no instance was it necessary to discontinue treatment because of discomfort. Results are shown in the Tables.

Table 1

Table II

Table III

Healing Times

Differences were observed in healing times. Superficial burns of between 20 and 30% total body surface area healed within 20-25 days when treated with PVPI cream with or without Aserbine, as opposed to an average of 36.5 days when treated with PVPI ointment plus Aserbine. Similar improved healing times were also seen in deep burns treated with the cream as opposed to those treated with the ointment plus Aserbine. Deep burns of between 40 and 50% total body surface area treated with the cream healed significantly faster than those burns of 20 to 30% total body surface area treated with the ointment plus Aserbine.
In all of the above cases, it is important to note that the present cream which contains half as much PVPI as the ointment had significantly faster healing times.

Bacteriology

A decrease in positive bacterial cultures was observed for S.aureus and P.aeruqinosa in burns treated with PVPI cream with or without Aserbine as opposed to those treated with the ointment plus Aserbine.

Complications

Apart from two patients who developed septicaemia which responded to systemic administration of tobramycin no other serious complications were observed.

A Comparison of the Killing Times of a PVPI Cream and a PVPI Ointment Against Staphylococcus Aureus

Materials

i) PVPI Ointment (Betadine, trade mark, ointment) available from Napp Laboratories, Cambridge.
ii) PVPI Cream, prepared in accordance with Example 2 above.

Medium

Trypticase Soy Bean Casein
Digest Broth (TSB) and Agar (TSA)

Test Organisms

Staphylococcus Aereus ATCC 6538

Method

Determination of Killing Time (KT)

A stock culture of the test organism was maintained on TSA slants and was transferred to TSB 24 hours prior to the test. 0.2 ml. of the TSB culture was added to 5g. of each agent. After mixing, a 4mm loopful of the mixture was removed at intervals and was transferred to 10 ml. of TSB. Following incubation for 48 hr. at 33◊C, all cultures were examined for growth. Organism viability and carry over controls were carried out and were positive for growth for each agent.
Two of the above tests were carried out. Results are shown in the Tables.

Table IV

Table V

Claims

A topical, antibacterial cream comprising an effective amount of povidone iodine distributed in a topical cream base characterised in that the topical cream base is an oil-in-water emulsion containing water and 20%t to 50% (w/w) of a mixture of at least one hydrocarbon component and at least one polyol moisturising component.
A cream according to claim 1 characterised in that the base comprises 25% to 40% (w/w) of a mixture of at least one hydrocarbon component and at least one polyol moisturising component.
A cream according to either claim 1 or claim 2 characterised in that the at least one hydrocarbon component comprises mineral oil, liquid petrolatum, white petrolatum or white ointment, preferably a mixture of liquid petrolatum and white petrolatum.
A cream according to anyone of claims 1 to 3 characterised in that the at least one hydrocarbon component comprises 15% to 40% (w/w), preferably 20% to 30% (w/w) of the topical cream base.
A cream according to any one of claims 1 to 4 characterised in that the at least one polyol moisturising component comprises glycerin.
A cream according to any one of claims 1 to 5 characterised in that the at least one polyol moisturising component comprises 5% to 20% (w/w), preferably 5% to 15% (w/w) of the topical cream base.
A cream according to any one of claims 1 to 6 characterised in that the weight ratio of the at least one hydrocarbon component to the at least one polyol moisturising component in the topical cream base is between 1 to 1 and 4 to 1 and is preferably about 2 to 1.
A cream according to any one of claims 1 to 7 characterised in that the topical cream base further comprises at least one emulsifier, preferably 1% to 15% (w/w) of at least one emulsifier.